Torsion of the testicular appendages: sonographic appearance

Strauß, Simon; Faingold, Ricardo; Manor, H

doi:10.7863/jum.1997.16.3.189

Cited by 53 publications

(50 citation statements)

References 4 publications

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“…1 Of these 4 structures, the appendix testis is the most frequently encountered, with a prevalence of 83% to 92%; the appendix epididymis is the next most common, with a prevalence of 20%. 6,7 These 2 structures are the most likely to undergo torsion.…”

Section: Discussionmentioning

confidence: 99%

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Manual Reduction of Torsion of an Intrascrotal Appendage Under Ultrasonographic Monitoring

Park

Lee

et al. 2007

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to evaluate the feasibility and safety of manual reduction of torsion of an intrascrotal appendage under ultrasonographic monitoring. Methods. Fifteen boys with torsion of an intrascrotal appendage, confirmed by scrotal ultrasonography and clinical status, were included in the study. The boys were 6 to 13 years old (mean age, 9 years). They all had painful, unilateral swelling of the scrotum and a palpable, tender nodule on physical examination. Scrotal ultrasonography indicated a single, variably echoic mass corresponding to the intrascrotal appendage. The mass was avascular according to Doppler ultrasonography. Thirteen boys underwent manual reduction under ultrasonographic monitoring. We tried to pull and release the swollen appendage in 8 patients and gently squeezed the appendage in 5. The procedure was considered successful when ultrasonography showed reperfusion in the appendage and the patients stated complete relief of scrotal pain. In 14 boys, follow-up scrotal ultrasonography was performed after the manual reduction. Results. Successful reduction was obtained in 12 (80.0%) of 15 boys. Only 1 boy was regarded as having reduction failure; this patient had intractable pain after the trial reduction, and ultrasonography showed transient vascular flow that promptly disappeared in the appendage. On follow-up ultrasonography, the maximal diameter ± SD of the intrascrotal appendages significantly decreased from 6.1 ± 1.2 to 4.0 ± 1.3 (P = .005) in 11 patients with successful reduction. Conclusions. Manual reduction under ultrasonographic monitoring seems to be a feasible and effective method for the treatment of torsion of an intrascrotal appendage to immediately relieve pain. Key words: scrotum; torsion; ultrasonography. Hospital, 1174 Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-021, Korea. E-mail: indawn@schbc.ac.kr he most common cause of an acute painful hemiscrotum in children is torsion of an intrascrotal appendage, which accounts for 35% to 67% of cases and is generally considered more common than testicular torsion.1 The ultrasonographic findings of torsion of an intrascrotal appendage are a spherical appendage of 5 mm or larger, increased periappendiceal blood flow, and no blood flow within the torsed appendage.2,3 The internal echogenicity of a torsed intrascrotal appendage is variable, appearing hypoechoic, isoechoic, and hyperechoic to the testis. Clinical findings for establishing a diagnosis are a blue dot visible through the scrotal skin (a blue dot sign), a black dot shown by transillumination, and a tender, palpable

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Section: Discussionmentioning

confidence: 99%

“…1 The ultrasonographic findings of torsion of an intrascrotal appendage are a spherical appendage of 5 mm or larger, increased periappendiceal blood flow, and no blood flow within the torsed appendage. 2,3 The internal echogenicity of a torsed intrascrotal appendage is variable, appearing hypoechoic, isoechoic, and hyperechoic to the testis.…”

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confidence: 99%

Manual Reduction of Torsion of an Intrascrotal Appendage Under Ultrasonographic Monitoring

Park

Lee

et al. 2007

Journal of Ultrasound in Medicine

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“…In testicular torsion, the pain is more severe and acute at onset compared with epididymoorchitis. Torsion of a testicular appendage accounts for 35-67% of all cases of acute scrotal pain in children (Strauss et al, 1997).…”

Section: Discussionmentioning

confidence: 99%

Protective Effects of Melatonin on Testicular Torsion and Detorsion Damage in Sprague-Dawley Rats

Aktaş¹,

Tuncer²,

Yıldırım³

et al. 2011

Int. J. Morphol.

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SUMMARY:In this study, we evaluated the ultrastructural findings of testis with systemic administration of different doses of melatonin during ischemic period in a rat model of testicular torsion/detorsion (T/D). Testis ischemia-reperfusion (I/R) injury was induced by torsion of the left testis, with a 720 degrees twisting of the spermatic cord so as to produce a total occlusion of testis for 2.5 hours. Subsequently, the same testis was then detorsioned. According to surgical procedure in each group, unilateral orchiectomies were performed for histopathologic examination. The groups were labelled as control group, torsion group (T), torsion and detorsion group (T/ D), torsion-detorsion and melatonin group (T/D+20,50 and 100 mg/kg melatonin). For the histological examination, testicular tissues were fixed in 2.5% glutheraldehyde and postfixation 1% osmic acid solutions. They were examined under transmission electron microscopy after application of contrast stained. In torsion group testis cross-sections, cytoplasm residues of mature sperms and large vacuole-like structures were noticeable. In detorsion group testis cross-sections, dissociations in spermatocide nuclei, many vacuoles and residual particles resulting from organelle degeneration, local voids in cytoplasms of spermatogonia, dilatation in granulated endoplasmic reticulum, large lipid droplets, chromatid particles, along with mitochondrial crystalisis were determined. In the testis cross-sections of the group of T/D+50 mg/kg melatonin administration, sertoli and spermatogonia cells that showed membrane-like structures and cytoplasmic voids were observed. Testis cross-sections of rats that were administered with T/D+50 mg/kg melatonin showed small mitochondrions and vacuole-like structures placed on the edge. Testis cross-sections of rats that were administered with T/D+100 mg/kg melatonin resulted in views similar to those of controls in the microstructural level. As a result, the most effective dose of melatonin, which was used in different doses, for prevention of ischemia/reperfusion damage was found to be 100 mg/kg.

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“…Torsion of testicular appendage is a common cause of acute scrotal pain in prepubertal males [1]. A firm nodule superior to the testicle with bluish discoloration of the skin (blue dot sign) is a characteristic physical finding.…”

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confidence: 99%

“…US findings are typical as described above. Other associated findings are scrotal skin thickening and reactive hydrocele [1,2]. US is usually done to rule out testicular torsion and epididymo-orchitis.…”

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confidence: 99%